Blood Pressure Problems

[Old Man River]

Hi Mobi,

I cannot give you any advice.

You are one of the good guys, look after yourself, I wish you well.

Good Luck

Moss

Same thoughts here.

[Mobi]

Hi Cuban,

Sorry for taking so long to reply, I have been away and have only just read your post, and thank you so much for taking all the time and trouble to provide me with such lengthy, and helpful comments.

You are quiet correct that the Harley Street medication programme was instituted some years ago now, based on my situation at the time, and is almost certainly out date. That is why, you may recall, that I mentioned my concern that no Thai cardiologist saw fit to change my medication, and one even agreed with me when I showed him a newspaper article on blood pressure control, and I suggested one of my medications could be changed, he said: ‘if I felt like it’.

Going back to the UK for consultations is just not a feasible option – and although cost is not critical, we are talking in excess of 30,000 baht for a single, 20 minute consultation, and God knows how much the blood tests , ECG’s would run to, to say nothing of an angiogram or worse. And I just couldn’t just hop on a plane, see a couple of docs, and hop back again. I would have to stay for a while; I have no home there, and the stress of all that would be worse than staying put in Thailand. As for ‘remote’ treatment – your comments about my change in lifestyle is equally true the other way around. I distinctly remember my diabetic specialist (who is extremely eminent and writes in medical journals etc) worrying about me eating Thai food, saying it contains all the ‘wrong’ ingredients. In a way that is true, but the generally the quantities are so small, that it negates the negative effects, and as most of my food is home cooked, and my wife is aware of ‘good’ and bad’ ingredients, I am quite sure I eat much more healthily than if I lived in the UK. So INMHO, I should stick with ‘Thai’ knowledge and not try to mix the two.

I won’t belabour the point, and it is true that Noel mainly railed against the administration, but if he had followed the advice at BP, he would have immediately gone under the knife at BP would never have undertook the radio and chemo therapy, and he probably wouldn’t have had those 3 extra months of life, which I know he wanted and appreciated. The problem with BP is not just overcharging per se. Their drive to maximise income also leads to misdiagnosing, and unnecessary treatments – some of it with dire consequences – all to make a few extra bucks. But the threads that Noel contributed to, and many others, are full of bad personal experiences at this hospital, and I’m sorry – there’s just too many for them to be coincidences or sour grapes. You hardly read anything bad about the top hospitals in BKK.

Anyway, I will continue my search for a good cardiologist here. Following Sheryl’s advice, I have now reduced my atenolol to 75 gms , and my pulse and doesn’t dip below 40 any more. The BP is still not very satisfactory, which is a worry, as I am now 80 days without alcohol.

Once again, many thanks for your valued advice.

Mobi

[Sheryl]

Glad to hear from you, Mobi, and glad your OK.

When you say BP is not very satisfactory, what exactly do you mean? And have you tried spacing out the meds?

Numbers aside, how do you feel?

[Mobi]

Glad to hear from you, Mobi, and glad your OK.

When you say BP is not very satisfactory, what exactly do you mean? And have you tried spacing out the meds?

Numbers aside, how do you feel?

Hi Sheryl,

As I reported before, the BP is high in the morning - around 150-155/55; drops after the meds kick in to around 115-125/55, then gradually increases during the afternoon/evening and is around 145-155/ 65 by late evening. The pulse hovers between early to mid 40's, never dipping into the 30's since I reduced the atenolol (now taken at night) to 75Mg.

I now take the Atenolol and Cardura ( for my prostate ) at night. Now I am back home. I will try switching the ramipril to night as well.

I use a battery powered (Omron) upper arm BP m/c, and always take a series of readings each time, to make sure I get a good average. I don't know why, but the Diastolic is always very stable, but the Sysytolic often moves around like a yo yo with each reading. I don't know if this is due to the vagaries of the machine, or my systolic pressure being quite volatile?

I feel OK, and am reasonably active, taking a brisk 20 minute walk with the dog, and 30 minutes swimming each day.

Yesterday I emailed my blood test sugars and BP results to my diabetes specialist at Bumrungrad, and asked her to set up appointments for me to see her, a cardiologist and a urologist?. Still awaiting a reply.

Edited May 8, 2007 by Mobi D'Ark

[Sheryl]

Systolic is always the more volatile. It changes from moment to moment in response to how forcefully your heart is pumping, hence it readily rises when you cough, sneeze, get angry, feel stressed, etc. The diastolic on the other hand reflects pressure in the vessels at rest (between heart beats) and is thus unaffected by such temporary events, and doesn't change much except over a long time.

Systolic BP is also the one most responsive to things like meditation, relaxation techniques and biofeedback. Since your diastolic is normal throughout you might consider trying these.

If you are going to see a Cardiologist at Bumrungrad (may as well if thast's where your diabetes doc is and you're happy with him/her), I'd suggest the following - this is based on qualifications, not personal experience as I haven't met him:

Dr. Chalrd Sombutr

Medical School:

- M.D. Chiengmai University, Thailand, 1965

Board Certifications:

- Diplomate of The American Board of Internal Medicine, 1971

- Diplomate of The American Board of Cardiovascular Disease, USA, 1973

Associate Professor, Chulalongkorn University

Fellowships: Cardiology, USA, 1973

Special Clinical Interests: Ischemic Heart Disease

Clinic Hours:

Monday 12:00 16:00 Heart Center

Wednesday 08:00 12:00 Heart Center

Friday 08:00 12:00 Heart Center

Sunday 10:00 14:00 Heart Center

Good luck

[Mobi]

Just for the record, and to wrap up this thread ( for the time being anyway), I want to report that I found a cardiologist at Bumrungrad – recommended to me by my diabetic specialist. She is Dr. Sureerat Panyarachun, and I have now had an echo stress test, and a heart CT scan. Thankfully, although some vessels have narrowed further, mainly due to high blood pressure, they are still not bad enough to warrant any stents.

During my stress test I had an ‘extra’ heart beat, when under stress, which was a bit worrying, but the doc thought it was due to an inadequate warm up period and isn’t too bothered.

We are ‘titrating’ my medication – some at night, some in the morning and reducing the atenolol, so that my heart beat stays above 40 per minute. My diastolic is very good, and the systolic just needs a bit of fine tuning. (Much as you were advising, Sheryl).

I will keep close watch and see her again in 5 weeks.

Ironically, it is my blood sugars that are more of a problem at the moment. I have to go to war on that now.

Thanks Sheryl, and others for all the advice.